D-dopachrome tautomerase predicts outcome but not the development of acute kidney injury after orthotopic liver transplantation

© 2018 International Hepato-Pancreato-Biliary Association Inc. Background: Elevated concentrations of D-dopachrome tautomerase (D-DT) were associated with adverse outcome in various clinical settings. However, no study assessed D-DT concentrations in patients requiring orthotopic liver transplantation (OLT). The aim of this observational study was to measure serum D-DT concentrations in patients undergoing OLT and associate D-DT with survival and acute kidney injury (AKI). Methods: Forty-seven adults with end-stage liver disease undergoing OLT were included. Areas under the receiver operating curves (AUC) were calculated to assess predictive values of D-DT for outcome and AKI after OLT. Survival was analyzed by Kaplan–Meier curves. Results: Serum D-DT concentrations were greater in non-survivors than in survivors prior to OLT (86 [50–117] vs. 53 [31–71] ng/ml, P = 0.008), and on day 1 (357 [238–724] vs. 189 [135–309] ng/ml, P = 0.001) and day 2 (210 [142–471] vs. 159 [120–204] ng/ml, P = 0.004) following OLT. Serum D-DT concentrations predicted lethal outcome when measured preoperatively (AUC = 0.75, P = 0.017) and on postoperative day 1 (AUC = 0.75, P = 0.015). One-year survival of patients with preoperative D-DT concentrations \u3e85 ng/ml was 50%, whereas that of patients with preoperative D-DT concentrations /ml was 83% (Chi2= 5.83, P = 0.016). In contrast, D-DT was not associated with AKI after OLT. Conclusion: In patients undergoing OLT, serum D-DT might predict outcome after OLT

Growing business intelligence: an agile approach to leveraging data and analytics for maximum business value

Introduction Several biomarkers have been suggested as early predictors of acute kidney injury (AKI) after orthotopic liver transplantation (OLT). Neutrophil gelatinase-associated lipocalin-2 (NGAL) appears to be a promising predictor of AKI after OLT, but the clinical benefit remains to be proven. Recently, systemic macrophage migration inhibitory factor (MIF) has been proposed as early indicator for requirement of renal replacement therapy after OLT. The aim of this prospective, observational pilot study was to compare the predictive values of serum and urinary MIF for severe AKI after OLT to those of serum and urinary NGAL. Methods Concentrations of MIF and NGAL were measured in serum and urine samples collected from patients undergoing OLT. Acute kidney injury was classified according to the KDIGO criteria, with stages 2 and 3 summarized as severe AKI. Areas under the receiver operating curves (AUC) were calculated to assess predictive values of MIF and NGAL for the development of severe AKI. Results Forty-five patients (mean age 558 years) were included. Nineteen patients (38%) developed severe AKI within 48 hours after reperfusion. At the end of OLT, serum MIF was predictive of severe AKI (AUC 0.73; 95% confidence intervals, CI 0.550.90; P = 0.03), whereas urinary MIF, serum NGAL, and urinary NGAL were not. On the first postoperative day, serum MIF (AUC 0.78; CI 0.620.93; P = 0.006), urinary MIF (AUC 0.71; CI 0.530.88; P = 0.03), and urinary NGAL (AUC 0.79; CI 0.640.93; P = 0.02) were predictive for severe AKI, while serum NGAL was not. Conclusion In the setting of OLT, MIF and NGAL had similar predictive values for the development of severe AKI.(VLID)487417

PLOS ONE / Transfusion of standard-issue packed red blood cells induces pulmonary vasoconstriction in critically ill patients after cardiac surgeryA randomized, double-blinded, clinical trial

Background Experimental and volunteer studies have reported pulmonary vasoconstriction during transfusion of packed red blood cells (PRBCs) stored for prolonged periods. The primary aim of this study was to evaluate whether transfusion of PRBCs stored over 21 days (standard-issue, siPRBCs) increases pulmonary artery pressure (PAP) to a greater extent than transfusion of PRBCs stored for less then 14 days (fresh, fPRBCs) in critically ill patients following cardiac surgery. The key secondary aim was to assess whether the pulmonary vascular resistance index (PVRI) increases after transfusion of siPRBCs to a greater extent than after transfusion of fPRBCs. Methods The study was performed as a single-center, double-blinded, parallel-group, randomized clinical trial. Leukoreduced PRBCs were transfused while continuously measuring hemodynamic parameters. Systemic concentrations of syndecan-1 were measured to assess glycocalyx injury. After randomizing 19 patients between January 2014 and June 2016, the study was stopped due to protracted patient recruitment. Results Of 19 randomized patients, 11 patients were transfused and included in statistical analyses. Eight patients were excluded prior to transfusion, 6 patients received fPRBCs (103 storage days), whereas 5 patients received siPRBCs (334 storage days). The increase in PAP (73 vs. 22 mmHg, P = 0.012) was greater during transfusion of siPRBCs than during transfusion of fPRBCs. In addition, the change in PVRI (15089 vs. -437 dyn·s·cm·m, P = 0.018) was greater after transfusion of siPRBCs than after transfusion of fPRBCs. The increase in PAP correlated with the change of systemic syndecan-1 concentrations at the end of transfusion (R = 0.64,P = 0.034). Conclusion Although this study is underpowered and results require verification in larger clinical trials, our findings suggest that transfusion of siPRBCs increases PAP and PVRI to a greater extent than transfusion of fPRBCs in critically ill patients following cardiac surgery. Glycocalyx injury might contribute to pulmonary vasoconstriction associated with transfusion of stored blood.(VLID)495023

Area under the ROC curve for development of any stage of AKI.

<p>Area under the ROC curve for development of any stage of AKI.</p

Serum concentrations of MIF and NGAL.

<p>Concentration of (A) serum MIF and (B) serum NGAL at 4 different time points: baseline (BL; under anesthesia before skin incision), day 0 (at the end of surgery), day 1 (24 hours after graft reperfusion on day 1 after OLT), and on day 2 (48 hours after reperfusion on day 2 after OLT). White bars indicate values of patients with no AKI or stage 1 AKI, gray bars represent values of patients who developed stage 2 or 3 AKI after undergoing OLT. P values indicate significant differences between groups.</p

Receiver operating characteristic (ROC) curves of MIF and NGAL for predicting severe AKI after OLT.

<p>(A) ROC curves of serum MIF (sMIF, solid line) and serum NGAL (sNGAL, dashed line) at day 0, day 1 and day 2 after OLT. (B) ROC curves of urinary MIF (uMIF, solid line) and urinary NGAL (uNGAL, dashed line) at day 0, day 1 and day 2 after OLT.</p

Demographic data of the study population.

<p>Demographic data of the study population.</p

Area under the ROC curve for development of severe AKI.

<p>Area under the ROC curve for development of severe AKI.</p

Urine concentrations of MIF and NGAL.

<p>Concentrations of (A) urinary MIF and (B) urinary NGAL at 4 different time points: baseline (BL; under anesthesia before skin incision), day 0 (at the end of surgery), day 1 (24 hours after graft reperfusion on day 1 after OLT), and on day 2 (48 hours after reperfusion day 2 after OLT). White bars indicate values of patients with no AKI or stage 1 AKI, gray bars represent values of patients who developed stage 2 or 3 AKI after undergoing OLT. P values indicate significant differences between groups.</p